Infusion Center Biller/Intake Specialist

This Jobot Job is hosted by: Cody Timm

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Salary: $25 - $30 per hour

Our client is a leading pharmacy in Southern California, and is seeking an experienced and detail-oriented Biller/Intake Specialist for their new infusion center. This crucial role ensures seamless patient onboarding, efficient billing processes, and optimal revenue cycle management as we continue to expand our services and deliver exceptional patient care.

• Competitive pay
• Great benefits package
• PTO and paid-holidays off
• Opportunity to join a fast-growing company!

Responsibilities:

1. Patient Intake and Insurance Verification:
2. Conduct comprehensive insurance verifications, including benefits investigation for infusion therapies
3. Obtain and manage prior authorizations for infusion treatments
4. Educate patients on insurance coverage, out-of-pocket costs, and financial assistance programs
5. Billing and Claims Management:
6. Process complex infusion therapy claims using appropriate coding
7. Manage drug wastage billing
8. Handle claim denials and appeals, particularly for high-cost specialty medications
9. Expertise in billing for both the drug and administration components of infusion therapy
10. Specialty Pharmacy Coordination:
11. Liaise with specialty pharmacies for medication procurement and billing
12. Manage split-billing scenarios for pharmacy-dispensed medications administered in the infusion center
13. Revenue Cycle Optimization:
14. Monitor key performance indicators (KPIs) such as clean claim rate, days in A/R, and denial rate
15. Implement strategies to reduce claim rejections and improve first-pass resolution rates
16. Stay updated on payer policies specific to infusion therapies and specialty medications
17. Compliance and Documentation:
18. Ensure compliance with Medicare and commercial payer guidelines for infusion billing
19. Maintain accurate and complete documentation to support medical necessity for infusion treatments
20. Patient Financial Counseling:
21. Provide clear explanations of infusion therapy costs and insurance coverage
22. Assist patients in navigating manufacturer assistance programs and copay support options

Qualifications:

• Bachelor's degree in healthcare administration, Medical Billing and Coding, or related field
• 3+ years of experience in medical billing, with specific experience in infusion center or specialty pharmacy billing
• In-depth knowledge of billing guidelines and specialty medication reimbursement
• Proficiency in infusion center management software and electronic health record systems
• Strong understanding of HCPCS Level II coding for drugs and biologicals
• Familiarity with USP standards and their impact on billing practices

Required Skills:

• Expertise in navigating complex prior authorization processes for high-cost infusion therapies
• Strong analytical skills for interpreting EOBs and resolving complex claim issues
• Excellent communication skills for interacting with patients, providers, and payers
• Ability to stay updated on rapidly changing billing regulations in the infusion therapy space

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